POS0603 CARDIOVASCULAR RISK FACTORS BEFORE ONSET OF RHEUMATOID ARTHRITIS ARE ASSOCIATED WITH CARDIOVASCULAR EVENTS AFTER DISEASE ONSET – A CASE CONTROL STUDY
Authors: H. Kokkonen, L. Johansson, H. Stenlund, S. Rantapää Dahlqvist
Journal: Annals of the Rheumatic Diseases (2022)

Background Increased comorbidity and mortality in rheumatoid arthritis (RA) patients are highly due to cardiovascular disease (CVD). The etiology of this increased morbidity and mortality in patients with RA compared with the general population is not fully understood. We have previously shown that individuals who subsequently develop RA have increased frequencies of several risk factors for CVD, such as elevated BMI, elevated Apoliprotein (Apo) B/ApoA1 ratio, and cigarette smoking compared with matched controls, already before symptom onset of RA. Objectives We aimed to assess the impact of CV risk factors, already present before onset of symptoms of RA, for future CV events (CVE) in comparison with matched controls. Methods A case-control study including 521 individuals before symptoms of RA and 1,566 matched controls identified in the Health Surveys of the Medical Biobank of Northern Sweden was performed. Information regarding the presence of the selected risk factors for CVD was based on surveys with data collected in the Västerbotten Intervention Programme (VIP) and the Northern Sweden Multinational Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA). Selected CVD risk factors were: hypertension, elevated Apolipoprotein B/A1 ratio, elevated body mass index, diabetes, and smoking. Information on comorbidities (coded according to the International Statistical Classification of Diseases and Related Health Problems ninth or tenth revision (ICD-9 and/or -10)) was requested from the Swedish National Patient Register and the Cause of Death Register. Statistics were performed using SPSS version 26.0 (IBM Corp., NY, USA), Cox proportional hazard regression was used and presented with calculated hazard ratios (HRs) and 95% confidence intervals (CI). Adjustments were performed for risk factors developed after RA onset. Results Pre-RA individuals had a higher risk for CVE after RA onset compared with matched controls (HR (95% CI)= 1.70 (1.31-2.21)) which remained after adjustment for various risk factors for CVD, (HR (95% CI)= 1.69 (1.24-2.30)). Also, treatment with biological disease modifying anti rheumatic drugs (bDMARDs) were associated with CVE (HR (95% CI)=2.06 (1.05-4.03), adjusted for CV risk factors). Most of the risk factors present prior to RA were associated with CVE after diagnosis, The significant association of risk factors present before RA onset for a CVE after onset remained after adjustments for risk factors that developed after RA onset. A combination of risk factors resulted in a higher risk in RA compared with controls (OR (95% CI); two risk factors 3.30 (1.16-9.36), vs. 1.21 (0.62-2.37), and three-four risk factors, 7.32 (2.71-19.74), vs. 4.16 (2.27-7.67). Conclusion Known risk factors for CVD present in individuals prior to onset of RA were associated with future CVE and even after adjustments for the risk factors, patients with RA had a higher risk for CVE compared with controls. In addition, risk factors present before RA was associated with future CVE even after adjustment for risk factors developed after RA onset. These findings further enlighten the importance of early assessment of risk for CVD in RA. References Disclosure of Interests None declared